“Recovery” in mental illness can be accomplished in two different ways.
In the first, which is widely researched by mainstream psychiatry, which may be called a “medication-based recovery” people are said to “recover” by taking suitable medications. But this does not mean they remain stable or overcome the potential to have further “breakdowns”. It is claimed that if they can arrive at an optimal dose of medicines, with medicinal support they can live their life in a relatively “balanced” manner, without the day-to-day chaos that a “mental illness” brings. This is pharma-led recovery, in which people consume their medicines throughout their life, and seek other interventions to accomplish daily tasks.
The second definition of “recovery” comes from those who have quit taking psychiatric medication and taken recourse to alternatives- either partially, completely or not at all. This is a “drug-free recovery”. In many instances such people identify themselves as ‘survivors of psychiatry’. They reject psychiatric labeling and diagnostic categories, defining their lives in their own ways, with support systems duly identified and worked out.
“Recovery” is fully possible in “schizophrenia” and “bipolar disorder”. There are scores of people who go off psychiatric medications for the rest of their lives. They live active professional, domestic, social and community lives with families around them, including spouse, children, colleagues, peers and communities. They take up jobs, create businesses or become homemakers- everything is possible.
John Nash the famous mathematician (of “A Beautiful Mind” film fame) who won a Nobel Prize gave up his medication for 25 years.
Taking medicine regularly is only a small part of a bigger responsibility. Everyone needs to understand why they are having such problems that require medicines. One has to be responsible and make suitable changes in their life and understand the underlying causes of their suffering. Taking medicine can reduce the so-called “symptoms”, it does not eradicate the reasons that produce suffering. To understand those reasons we need to look for them in day-to-day situations; an examination which may not be easy by oneself. This is where an outsider offering counseling support may be helpful. Medicines help with symptoms, whereas counseling helps people to unravel the sources of distress.
Counseling can be equally as effective as medicines in a majority of cases. Instead of referring someone to a psychiatrist first, they can easily be referred to a psychologist, counselor or therapist. Many times matters resolve simply by talking about them and no further action is needed.
People prefer to take medicines because they think counseling is “mere talk” and simply talking cannot help. They prefer something which is more “tangible”; where they can see something happening. Putting a pill in the mouth is certainly tangible/concrete and in the short run produces immediate effects on the brain chemistry. It is only in the long term that their side-effects and debilitating outcomes start emerging.
There are more reasons, some of which follow. The list is not exhaustive.
Dealing with the (unpleasant) truth– By talking it out you will have to deal with certain unpleasant realities about yourself and your family. A lot of times people prefer to remain silent, or look the other way, rather than talk openly, even if they are alone. For example, if a young man’s anxiety is coming from a family where his father is constantly berating him/others, how easy is it for him to deal with his father? It is far easier for him to pop in a pill!
Lack of family support in counseling– In a number of cases people who seek counseling help come alone to talk about their issues. So even if they understand their problem, until their families also understand and support them things cannot move in a progressive manner. Therefore it is important that families be counseled together. But in a vast majority of cases not every person in the family is willing to communicate with a stranger or pay heed to their insights. Counseling in such a scenario becomes difficult, especially if those individuals are dominant in the family milieu.
Change is uncomfortable– When you seek counseling support, you should be ready to change certain things about yourself or your situation. For instance if it is necessary for you to do some physical work, you should be ready for it, and not say that you have domestic help that can manage all the work. If you need to train for a marathon, you have to learn to get up early in the morning, isn’t it? Renewing a life from psychiatric illness is like running a marathon- you build your capacity slowly and challenge your comfort zones. Living in the comfort zone is very unthreatening, but there is no growth happening there either. If you want comfort or you want growth- you have to make the choice, you have to take the call.
Lack of continuity– Often people do not appreciate how regular counseling can help. They opt for counseling only when they have a crisis to deal with- which may be once a year or even once in a few years. If counseling is to be effective and long lasting, the relationship with a counselor can become a major support system in someone’s life. By going into counseling regularly, which can be anything between once in three weeks to once a month/two months, a trust is created. Working in trusted relationships is less difficult than working anew every few months/years. Fire-fighting of this sort also does not let the counselor help you understand your problem areas, if they can identify them, or help you deal with them successfully.
Recovery orientation itself is a new concept which is yet to be embraced by psychiatry. Psy-professionals also counsel clients, but their emphasis is only on drug-dependent “recovery”. They mostly do not have the time, or tools to listen to patient stories and dissect their family situations.
Even in case of other counseling ‘professionals’ since their knowledge base comes from psychiatric diagnostic categories, they do not have ideas about how to deal with the complex dynamics of people’s families, social, economic, spiritual and financial dilemmas. A major part of their counseling is to ensure compliance for psychiatric medication, and some behavioural changes. This is also the goal of cognitive behavior therapy (CBT) and a host of other ‘therapies’. Patient recovery is usually not among their goals.
To benefit from “recovery” oriented counseling following criteria are recommended-